Tag Archives: wellness program

Pinch Me! A Healthcare Program That Works

Those of you who are regular readers of this column may have noticed my postings usually observe that most vendors don’t save money — for example, Wellness: An Industry Conceived in Lies, Retractions and Hypocrisy. (Note that this particular article was accompanied by an editorial in which Paul Carroll, ITL’s fearless leader, described how he had asked the perpetrators for rebuttals, but no one had stepped up.)

So it is with great satisfaction that I can finally recommend a company to ITL readers: Quantum Health, which really does save significant money while providing a better employee experience. One might ask: “Wait—you just said the wellness industry is conceived in lies, retractions and hypocrisy. How is Quantum any different?”

Simple: Quantum isn’t a wellness company. It’s sui generis. If categorized at all, it would be called “coordinated care.” Unlike a wellness program, Quantum doesn’t require or even involve health risk assessments, biometric screenings and checkups. Instead, Quantum leaves employees alone unless they’re sick, are high utilizers or ask for help.

Unlike wellness programs, Quantum’s offering is not bolted on to existing administrative programs. Instead, it replaces them, assuming most of the member interface functions from the carrier. Whereas, within a carrier, those functions are siloed — often in different buildings, always with their own budgets, targets and incentives — Quantum is organized by customer, with all the functions for that customer comingled.

The advantage of that arrangement is best described with a story. Once, when I was on a site visit at Quantum, an employee of a new customer called, asking if diabetic shoes were a covered benefit. In most, if not all, carriers, the person answering that query would be evaluated based on accuracy, number of rings, politeness and how many calls they handled that hour. So the person would say “yes” or “no” and then get off the phone. At Quantum, the agent answered the query but was prompted by the supporting software (and by training) to recognize that question as a red flag. Here was an employee whose diabetes was already so advanced he was asking about shoes…and yet he was nowhere in the diabetes registry. A typical carrier wouldn’t find out about this person until after the inpatient claim for his inevitable crash was filed, warehoused, prioritized and queued for telephonic outreach. And then, assuming the carrier had the correct phone number, and this patient answered the call and was receptive, rehabilitation could begin. And yet there he was – right on the phone – asking for help. So the agent probed a little further and then transferred him to a nurse in the same pod, who engaged him right away, almost certainly avoiding or forestalling a future high-cost medical event.

This is just one of many examples of touches that allow Quantum to save your clients more money than any other vendor of any other population health management service. I can guarantee this.

This performance also does not come on the backs of employees. Satisfaction rates are very high, and no one has to be bribed or penalized to participate, as happens with wellness, where the average bribe/penalty has almost tripled in five years, to $594.

Before you get too excited, here are the catches.

First, the carrier has to be willing to give up a chunk of its administrative services…and, more importantly, its administrative fees. It is unlikely that the administrative services contract that your client signed anticipated that, meaning the concession has to be negotiated.

Second, even once that concession is extracted from the carrier, the incremental fee for Quantum will in total generate a higher total administrative cost — Quantum fields several times as many member calls, often lasting several times longer than the calls of the carrier being replaced.

Third, to encourage inbound phone calls at the right times, like when a specialist referral or other high-cost resource is recommended, you need to tweak the benefits design to vary the co-pays according to whether the employee is willing to take the extra step of a phone call. Because of this financial incentive, these phone calls tend to come in at exactly the right times, when an employee is in the midst of an episode of care, and is about to fall into the “treatment trap.” That is the point at which patients are most concerned and most receptive to assistance. All good, except that human resources executives are often reluctant to tweak benefits designs.

Finally, Quantum needs to control its growth, because its performance relies to a large degree on staff training and experience. As the only vendor that has cracked the coordinated care nut, they can’t handle all comers. Consequently, they focus instead on large and jumbo employers. Therefore, you would need a minimum case size of 1,000 employees to engage them.

Still, the outcomes advantages that Quantum confers are compelling.

(Disclosure: There are no disclosures. I am not a shareholder and do not get commissions from Quantum for articles like these.)

Care Transparency – What Employers Are Missing!

Employers are trying hard to reduce health care costs and create a healthier, more-productive workforce. They have tried to optimize employee usage of services offered by their health plans and invested in wellness programs. They are now beginning to consider (or have implemented) cost transparency tools and second opinion and telemedicine services.

All these approaches are right!

What employers are missing is an understanding of how employees are making health care decisions and how that impacts their health care costs.

A large population of health care consumers are starting with a search engine to find health care information online. In the past year, 72% of U.S internet users have gone online specifically for health related information, and 77% of them begin their research at a search engine.1

And age has nothing to do with it!

Of those who seek health information online, 73% are 50 years of age or older.

At the same time, many doctors are urging patients to not rely so much on Google for health research. Doctors lament that they often have to correct misinformation or incorrect conclusions after patients do health research online.2

Even when employees go to a reputable site such as WebMD or a health plan’s member portal, they end up with a laundry list of treatment options. Try running a search for back pain — you will end up with more than two dozen treatment options. Health care consumers don’t know what is effective, appropriate or necessary, so most follow recommendations from friends or family or go through trial and error based on what they read online. Here are a few treatment decisions for back pain:

  • Buy a heating pad
  • Buy a muscle relaxant
  • Buy over-the-counter drugs
  • Go to the chiropractor (the one Uncle Bob recommended)
  • Go get massage therapy
  • Do yoga
  • Go to a doctor
  • Go to an orthopedic specialist (because your friend swears by it)

You get the point.

Each wrong treatment decision costs employers money — $235 per treatment decision, to be specific.3

Multiply that by the number of employees in your organization (and their dependents) and number of treatment decisions they make.

This is a huge avoidable cost.

Phone consultation services such as care/disease management or health advocacy are not going to stop employees from going online for help. It doesn’t make sense for employees to be calling someone every time they have a question regarding their health issues.

Employers also need to meet employees where they are — online. Employers need to provide them with tools that can help their research and decision making process with robust, accurate, unbiased and evidence-based information.

Employers can help create care transparency by offering Treatment Selection and Shared Decision Support tools. Employers can significantly improve the quality of care consumed by their employees and reduce health care costs by focusing on creating care transparency.

In my next article, I will write about the types of tools that will be effective in supporting employee decisions and the type of tools that employees will really use in making care/treatment decisions.


1 77 Percent Of Online Health Seekers Start At Search Engines [Pew Study]

2 Doctors Warn Against Relying Too Much On Google

3 WiserTogether, Inc research